Robbins Ch. 20 - The Kidney II Flashcards
MPGN
pattern, not disease
-proliferation of mesangium and capillaries
can be combined - nephrotic/nephritic
proliferating mesangium splits BM
subendothelial deposits, IgG, C3, C1q, granular
MPGN type I
prognosis of MPGN type 1
50% to ESRD within 10 years
alpha-1 antitrypsin deficiency
familial emphysema
-MPGN Type 1 - secondary form
cryoglobulinemia
Hep B/C - MPGN type 1 - secondary form
excessive alternate complement pathway
MPGN, type II, dense deposit disease
C3NeF
dense deposit disease
prognosis of DDD
50% to ESRD
90% recurrence in transplants
berger disease
IgA nephropathy
most common GN worldwide
mesangial IgA deposits
IgA nephropathy
celiac disease
IgA nephropathy
clinical for IgA nephropathy
20-30yo, males
gross hematuria following infection of resp, GU, urinary tract
EPISODIC hematuria
prognosis for IgA nephropathy
15-40% to ESRD over 20 years
recurrence frequent in transplants
episodic hematuria
IgA nephropathy
berger disease
not systemic disease - IgA nephropathy
henoch schonlein purpura
is systemic disease - IgA nephropathy
- skin lesions on buttocks
- systemic vasculitis
nerve deafness, eye disorders, hematuria
alport syndrome
alport genetics
85% X-linked - males full / females only hematuria**
also autosomal dominant and recessive forms
basket weave GBM
alport syndrome
age for alport
5-20 years old
renal failure age 20-50 years old
benign familial hematuria
thin basement membrane lesion
excellent prognosis
mutations in alpha3, 4 of collagen 4
thin basement membrane lesion
genetics of thin basement membrane lesion
most patients - heterozygote
RPGN progression?
90% to chronic GN
chronic GN
kidney contracted - granular surface
- thin cortex
- arterial sclerosis
- obliterated glomeruli
need dialysis/transplant
SLE
nephrotic syndrome
- stage 4 - diffuse proliferative most severe
- > 50% glomeruli involved
subendothlial deposits and wire loops?
SLE
smith antigen
SLE
dsDNA, IgG, C3 subendothelial deposits
SLE
wegeners
granulomatosis with polyangiitis
henoch schonlein
skin lesions
children 3-8yo
IgA mesangial deposits
children - good prognosis
30% of ESRD patients
diabetic kidney disease
diabetic nephropathy
hyperglycemia - glycosylation of BM
- increased mesangial membrane and sclerosis
- granular kidney exterior
changes in diabetic nephropathy
1 - capillary BM thickened
2 - diffuse mesangial sclerosis
3 - nodular glomerulosclerosis (kimmelstein wilson disease)
kimmelstein wilson disease
nodular glomerulsclerosis - in diabetic nephropathy
IgG-IgM deposits
essential mixed cryoglobulinemia
-MPGN type 1 - Hep C infection
50% of acute kidney injury in hospitalized patients
acute tubular injury
endothelin
vasoconstriction
ethylene glycol
ballooning and hydropic or vacuolar degeneration of PCT
-also - calcium oxalate crystals in lumens
tam horsfall proteins
seen in ATI
-hyaline casts - distal tubules and CDs
toxic ATI
continuous necrosis
ischemic ATI
patchy necrosis
stages of ATI
initiation - oliguric, increased BUN, after surgical event
maintenance - decreased urine, hyperkalemia**, rising BUN
recovery - increased urine, hypokalemia, BUN to normal
prognosis of ATI
90% recover with toxic - if removed early
50% mortality with shock, sepsis, burns, multi-organ fail
proximal tubules
can regenerate
distal tubules
don’t recover that well
can’t concentrate urine
tubulointerstitial nephritis
often polyuria, polydipsia
95% cystitis
bacterial infection
most common cause of pyelonephritis
ascending infection - from lower UT
50% of UTI in children
have VUR
pyonephrosis
pus in pelvis and calyces
perinephric abscess
pus through renal capsule
glomeruli
relatively resistant to infection
casts
indicate renal involvement - only formed in tubules of kidneys
polyomavirus
transplant patients
nuclear enlargement and intranuclear inclusions
polyomavirus infection in transplant patients